Nieman: Not always an obvious cause for teenage fatigue

Recently the “sociologist” in me prompted an experiment with my peers in which I asked them, “How do you manage a tired teenager?” The most common response was, “Where do you want me to start?” The answers were often accompanied by deep sighs and marked frustration, with a heavy accentuation on “where” and “start.”

The causes of tired teens may seem obvious to many doctors and parents: get enough sleep and all will be well; blame electronics and get rid of smartphones at bedtime, thus reducing the odds of disrupting normal physiology and “changing” teens into vampires who text sexual messages long after midnight (This habit is known as “sexting” and “vamping.”)

When we meet with tired teens, pathology plays a far smaller part than the impact of lifestyle choices, and if we truly care more about the patient than the disease, we learn so much more about families we encounter.

According to the Yale Sleep Clinic for Children and Youth, only 10 per cent of teens consistently get the required amount of sleep every 24 hours (ideally between eight and 10 hours of sleep is suggested). Dr. Craig Canapari, who directs this clinic, laments the fact that many parents are poor role models when it comes to a healthy sleep routine.

We know by now that a teenager’s brain is still under construction. The common understanding is that this “evolution” ends around 25 years. We also know that teens have different biorhythms. Teens tend to get sleepy late at night and they are slow to wake up in the mornings.

Despite this established research, science has been impotent in convincing school boards to allow teens to start school a bit later in the mornings. A few jurisdictions got in sync with this fact, but the majority of schools in North America will continue to demand that tired teens stick with the traditional start of a school day.

Although it may be obvious that exercise before sleep, caffeine use later in the day, exposure to bright electronic screens at bedtime, going to bed too late, and being under pressure because of an overcommitted life can erode proper rest, there are some less obvious causes that are either missed or forgotten.

Obese patients are at risk for sleep apnea which is often missed until a teen sleeps with parents in a hotel room. A parent may discover that the teen snores, but also pauses their breathing for longer than 10 seconds. Undiagnosed sleep apnea also may impact a patient’s cardiovascular health.

Another subtle cause for poor sleep is restless leg syndrome. It may be uncommon, but it is a very real condition and is often associated with a low iron level — also a medical cause of fatigue.

Narcolepsy in teens is very rare, but when it happens the symptoms are dramatic and “entertaining” to a teen’s peers — especially when a teen falls asleep unexpectedly and in unusual places.

More researchers are studying the effects of cannabis use on the teenage brain.Tony Caldwell /
Tony Caldwell/Postmedia Network

In all my research on this topic, I was surprised how infrequently experts in the field discuss the role of cannabis as a cause of fatigue. Drugs, in general, are mentioned consistently, but how cannabis impacts sleep is still a bit of a blind spot.

A great number of teens are moody; nobody is too surprised by this. However, many parents who think their teen is moody later discover that it was really the pre-dawn of depression. I am never surprised to learn that a depressed teen self-medicated with marijuana, which is easier to buy than cigarettes.

Many of these teens have heard about the medical uses of cannabis and when they research this issue online, there are plenty of websites delivered by non-professional “experts” who are pro-marijuana and who will explain that there are two kinds of cannabis (a product that excites and a product that calms).

Because the use of cannabis in teens is expected to climb higher — Canada already leads the world when it comes to the use of this substance in children and youth — more research is expected to be done via MRI scans and sleep studies.

In a 2014 edition of the Journal of Neuroscience, researchers from the University of Pennsylvania shared data which shows that the amygdala — the part of the brain which controls emotions — has a different anatomy in teens who smoke cannabis. These researchers also showed that the earlier a teen starts to use weed, the more likely that individual will end up with sleep problems later in life.

We know that REM sleep restores and refreshes us. Cannabis is known to reduce the amount of time in REM sleep. Users dream less. However, when a teen eliminates the habit of consuming cannabis there may be a rebound effect where they dream more and the dreams are often unpleasant, making it more likely for them to resume the habit to sleep “better.”

Helping tired teens may have become more complex than simply getting rid of smartphones at bedtime.

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